Butorphanol (Stadol)
opioid agonist-antagonist Benefit: Less habituation Downside: Weaker Response
Nalbuphine (Nubain)
opioid agonist-antagonist Benefit: Less habituation Downside: Weaker Response
Narcan (Naloxone)
opioid antagonist
Acetaminophen (Tylenol)
Analgesic, Antipyretic, not anti-inflammatory, blocks pain impulses by inhibiting prostaglandin synthesis CENTRALLY, liver is main organ of concern,
Acetylcysteine (Mucomyst)
antidote for acetaminophen
NSAIDs
Inhibition of leukotriene pathway, prostaglandin pathway, or both, Organs of concern: stomach and kidneys
Salicylates (Aspirin) NSAID
anti-inflammatory, anti platelet, antipyretic
Misoprostol (Cytotec)
inhibits acid and stimulates production of mucus, help with effects of NSAIDs, Cat X
Corticosteroids (Prednisone)
• Strong anti-inflammatory medications (at all levels)
•
Decrease prostaglandin and suppress inflammation
• Prolonged use
can lead to adrenal suppression and would need tapering down
Triptans (Imitrex)
Stop migraine while happening; vasoconstriction
Ergot Alkaloids: Migranal
To abort migraine if triptans unsuccessful; vasoconstriction
Lidocaine (Xylocaine)
local anesthetic; an amide that stops axonal conduction by blocking sodium channels; primary use is medical or dental procedures; more towards cox 1
Celecoxib (Celebrex)
COX-2 inhibitor selective
Procaine (Novocain)
ester local anesthetic
Etomidate (Amidate)
general anesthetic; GABA enhancing; Sedative Stage IV
Propofol (Diprivan)
general anesthetic Stage IV
NMBDs
prevent nerve transmission in certain muscles, resulting in muscle paralysis, do not cause sedation or pain relief
Succinylcholine (Anectine)
Depolarizing neuromuscular blocker, short half life, muscle contracts and slowly relaxes
Mivacurium (Mivacron)
Non-depolarizing neuromuscular blocker agent, prevent contraction, longer half life
Benzodiazepines
Sedative hypnotic, anxiolytic, depress CNS activity
Diazapam (Valium)
Class: Benzodiazepine, long acting; sedative- hypnotic;
anticonvulsant; schedule IV drug.
Mechanism of Action: potentiates effects of inhibitory
neurotransmitters. Raises the seizure threshold. induces amnesia and
sedation.
Adult Dose:
Seizure activity: IV 5-10 mg
q 10-15 mins PRN (5mg over 5
minutes) ( max dose:30mg)
Pedi dose:
Seizure activity: 0.2 mg/kg to 0.5 mg/kg slow IV q 2-5 mins up
to 5 mg (max dose 10 mg)
Rectal diazepam: 0.5 mg/kg via 2" rectal catheter and flush
with 2-3 ml air after administration.
Indications: Acute anxiety states and agitation, acute alcohol
withdrawal, muscle relaxant, seizure activity, sedation for medical
procedures ( intubation,ventilated patients, cardioversion) may be
helpful in acute symptomatic cocaine overdose.
Contraindications: Alcohol, increased icp, coma,
Adverse reactions: respiratory depression, reflex tachycardia, headache
Alprazolam (Xanax)
Benzodiazepine (intermediate acting)
Lorazepam (Ativan)
Benzodiazepine (intermediate acting)
Temazepam (Restoril)
Benzodiazepine (intermediate acting)
Flumazenil (Romazicon)
Benzodiazepine antidote
Nonbenzodiazepine hypnotics
used to treat insomnia; Zolpidem (Ambien), Eszoplicone (Lunesta)
Barbituates
Enhance GABA, inhibit nerve impulses in the cerebral cortex, enzyme inducers, sedative, AED
Phenobarbital (Luminal)
Barbiturate
muscle relaxants
Act to relieve pain associated with skeletal muscle
spasms
Majority are centrally acting
CNS is the site of
action
Similar in structure and action to other CNS
depressants
Direct acting
Act directly on skeletal
muscle
Closely resemble GABA
Baclofen (Lioresal)
Muscle Relaxant
Cyclobenzaprine (Flexeril)
Muscle Relaxant
Methocarbamol (Robaxin)
Muscle Relaxant
Ketorolac (Toradol)
class: nonsteroidal anti-inflammatory agents,
nonopioid analgesics
Indication pain
Action: Pain relief due to prostaglandin inhibition
Nursing Considerations:
-may cause GI bleeding,
Stevens-Johnson Syndrome, anaphylaxis, drowsiness
- should not
exceed 5 days of therapy
- bleeding risk increased with garlic,
ginger, and ginkgo
- may decrease effectiveness of hypertensive
medications and diuretics
Ibuprofen (Advil, Motrin)
NSAID
Naproxen (Aleve)
NSAID
Nitrous Oxide
• Analgesia caused by suppression of pain mechanisms in the
CNS
• Laughing Gas
• Does not induce surgical anesthesia,
combined with other surgical anesthetic agents
Opioid Agonists
Analgesic response
Morphine
Opioid Analgesic, Cat 2 agonist
Hydromorphone (Dilaudid)
Opioid agonist, 7-10x stronger than morphine, Cat 2
Fentanyl (Duragesic)
opioid agonist, 100x stronger than morphine, must be on opioids already to receive
Antiepileptic Drugs (AEDs)
Drugs that reduce or prevent seizures
Carbamazepine (Tegretol)
Desensitizes Na channels, avoid grapefruit juice, normal level is 4-12 mcg/mL
Hydantoins
phenytoin, fosphenytoin
Phenytoin (Dilantin)
Anticonvulsant except for absence, 10-20 mcg/mL, highly bound to protein, give with saline
Fosphenytoin (Cerebyx)
Anticonvulsant, version of phenytoin that has to be metabolized by the liver
Valporic Acid (Depakene)
50-100 mcg/mL, anticonvulsant, hepatotoxic
Lamotrigine (Lamictal)
Anticonvulsant, can result in Stevens-Johnson syndrome
Second-Line Anti-epileptic Drugs
Not used by themselves
Gabapentin (Neurontin)
used for neuropathic pain and anticonvulsant
Pregabalin (Lyrica)
Anticonvulsant and for neuropathic pain